Saturday, December 18, 2010

"He's in charge"

 That last post reminded me of this story.
 Back when I made the jump from CFR to EMT (many moons ago) I found myself doing clinical time in the E/D for the first time. I was intimidated, to say the least trying to find a friendly face that I could hook onto for the shift and follow around. I was desperate for somebody to give me something to do or ask me to help them. It was almost as if I wasn't there, they all ignored me. I was uncomfortable.
 After about an hour of me trying to do something, one of the Techs felt sorry for me and had me doing regular rotations of vitals or checking on patients for nothing in particular. I didn't feel very useful, but at least I felt like I was doing something to fill the hours.
 Then an ambulance thankfully came in and dropped a patient. I was to help get this one 'set up', but wound up calming the family and explaining to them what was going on and why. After the initial assessment, blood draws, interview, etc. the patient was left alone to await test results and all the data collection. I stayed in the room talking to him, retaking manual vitals, and calming his wife. He was on a backboard (sorry: Trauma patient, fell down three steps on his back porch and struck his head on a concrete planter) and had a collar on. He was complaining about the collar. I checked it out and found it was the wrong size and had been put on wrong. Part of it was sticking up into the fleshy part medial to the mandible. It LOOKED painful. I told him I would see about getting it corrected. I went to see his RN and explained the problem. "Can't touch him until Doctor checks him out." He said without even looking up at me. "Yes, I understand, but this is just wrong and the guy is in pain needlessly. Can't you talk to the Doc?" I asked. "Nope, the Doc will see him in a little while, when he is ready."
 A little while came and went. I checked on my patient several times. It was really getting to him, and now his wife was getting agitated and threatened to take it off herself. I explained why that would be a bad idea and said I would be right back.
 The Doctor was sitting at the Nurse's station and not doing anything in particular. I sized him up. He looked like the scary type that grew a booming voice when he got pissed. I didn't like my odds, but I thought about the patient and screwed up my courage. Me, just a piss-ant EMT wanna-be, suggesting what the Doc should be doing. This isn't going to go well, but I felt I had no choice.
 "Um, excuse me, Doctor?" He looked up, annoyed that I had interrupted his conversation with the attractive Nurse. "Yes?" Oh man, this was a bad idea. "Um, well, the patient in 14 has an extrication collar on that is the wrong size and it is placed improperly. I wouldn't bother you but it is causing him a lot of discomfort and he is threatening to take it off." "Could you take a look at it, and maybe we could fix it?"
 Oh, the look of disgust on this Doctor's face made me want to just leave and never come back. But he got up and lumbered over to the room.
 "You see Doctor, here where the collar is stabbing him under the chin and he has all the irritation? That's not right. The collar is too small, it should not hurt him like this." The patient chimed in and helped me out a bit, confirming in clear words the distress he was feeling. Of course, when the Doctor went into the room, he was followed by the E/D Tech and the RN, who I believe were just there to see me get my ass reamed out.
 The Doc looked things over, nodded, and turned to the Tech and said "Go get me another one of these, the correct size". The Tech took off and came back a few minutes later with a box which he handed to the Doc. The Doc opened it up and found a nice soft, cushy cervical collar. He looked at the collar, looked at the Tech, then threw the collar across the room. "That's not what I asked for! I want one of these!" and he pointed at the collar on the patients neck. "But Doctor" the Tech protested, "We don't have those, only EMS uses them." The Doc didn't care, "Just get me one that fits, FIND one!"
 Yeah I guessed right, this Doc had a temper. "It's OK Doc, I got this." I said and left the room. I went over to where the E/D staff dumps all the EMS gear when they take it off of patients. I grabbed a stifneck and cleaned it. When I turned to return with it, I found that they had all followed me out to see where I was going. "Here you go Doc" and I handed it to him. The parade headed back into the patients room.
 The Doc took charge "OK, here's how this is gonna go: I'll take his head, you (pointing at the Tech) are going to remove this collar, and he (pointing at ME!) is going to teach us all the proper way to put one of these on. He's in charge. Everybody got that?" He looked at me and in an easy going tone said "now you just give us a little coaching and explain what you are doing, what you are looking for, and why, OK?" "Yeah Doc, this is really easy, first let me show you how to set the size on these collars...."
 So in less than a minute, we had it done, the patient was grateful and more comfortable, and I felt useful. I was also a little embarrassed, but I broke the ice with the floor staff and the evening went along a little more quickly.
 Sometime in the middle of the night I found myself slumped in a hallway chair taking a 5 minute break, and the Doc was slumped in the chair next to me doing the same. "Thank you Doctor" I said. "FOR WHAT?" he said in a snotty voice. I looked up to see him smiling sideways at me. "For taking the time to listen." He leaned back so he could look at me. "Let me tell you something. Never ever be shy about speaking up for your patient. If something isn't right, SAY something. Most Doctors are self-important assholes. We just don't like to admit it. Sometimes you need to remind us that there is a patient in need. That's what you did earlier, and if I ever stop listening to people who point those things out, then that's the day I retire. Good luck with whatever you do, kid." We both went back to work.
 I miss that Doc. Everybody though he was an ass except me and a couple of Nurses.

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